AdventHealth
Overview
Social Work Care Manager role at AdventHealth Location: 2525 S DOWNING ST, Denver, 80210 | Schedule: Part-time | Shift: Days The Social Work Care Manager intervenes with patients who have complex psychosocial needs, require assistance with eligibility determination for social programs and funding sources, and may require assistance with transitions of care or discharge planning. The role includes crisis intervention for patients and families with psychosocial needs and coordination of discharge plans for high-risk patient populations. The Social Work Care Manager collaborates with the patient/family and the interdisciplinary team to ensure patient-centered care coordination across the continuum of care and to promote efficient, cost-effective care delivery. The Social Work Care Manager supports transitions of care planning and communicates with the care team to enhance patient flow and continuity of care.
Responsibilities
Assess patients and families for discharge planning needs in inpatient, observation, and emergency department settings, including functional status, support systems, financial and psychosocial factors.
Review medical records and integrate clinical, social, and financial factors into the transition of care plan.
Develop discharge plans with contingency plans to ensure timely care coordination and progression of care, arranging post-acute services and community care for social needs.
Leverage technology and standard work practices to communicate with post-acute care services and facilities to ensure complete medical records, accurate discharge reconciliation, and continuity of care.
Coordinate with the patient/family, care manager nurses, nurses, physicians, and the interdisciplinary team to ensure patient-centered care across the continuum.
Monitor resources and escalate clinical care as needed to support efficient and cost-effective care.
Evaluate post-hospital needs and develop transitions of care plans; initiate implementation prior to discharge.
Improve patient flow/throughput, continuity of care, patient satisfaction, safety, readmission prevention, and length of stay management.
Participate in daily multidisciplinary rounds and contribute to care coordination, discharge planning, and transitions of care planning.
Educate nurses, physicians, and the interdisciplinary team on resource utilization, medical necessity, CMS CoP for discharge planning, and care coordination.
Be knowledgeable about post-hospital services available to patients, including Home Health, Infusion, Durable Medical Equipment, Palliative Care, Hospice, Outpatient Services, Transitions of Care clinics, Skilled Nursing Facilities, Rehabilitation Services, and Community-based Organizations.
Qualifications
Master's in Social Work (MSW)
3 years experience in hospital/medical social work
Preferred Qualifications
Knowledge of state and federal guidelines pertinent to care management
Care Management discharge planning experience
LCSW (Licensed Clinical Social Worker)
ACM (Accredited Case Manager) or CCM (Certified Case Manager) preferred
This facility is an equal opportunity employer and complies with federal, state, and local anti-discrimination laws and regulations. Salary ranges reflect the anticipated base pay for this position and depend on skills and experience. Location may affect minimums and maximums.
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Social Work Care Manager role at AdventHealth Location: 2525 S DOWNING ST, Denver, 80210 | Schedule: Part-time | Shift: Days The Social Work Care Manager intervenes with patients who have complex psychosocial needs, require assistance with eligibility determination for social programs and funding sources, and may require assistance with transitions of care or discharge planning. The role includes crisis intervention for patients and families with psychosocial needs and coordination of discharge plans for high-risk patient populations. The Social Work Care Manager collaborates with the patient/family and the interdisciplinary team to ensure patient-centered care coordination across the continuum of care and to promote efficient, cost-effective care delivery. The Social Work Care Manager supports transitions of care planning and communicates with the care team to enhance patient flow and continuity of care.
Responsibilities
Assess patients and families for discharge planning needs in inpatient, observation, and emergency department settings, including functional status, support systems, financial and psychosocial factors.
Review medical records and integrate clinical, social, and financial factors into the transition of care plan.
Develop discharge plans with contingency plans to ensure timely care coordination and progression of care, arranging post-acute services and community care for social needs.
Leverage technology and standard work practices to communicate with post-acute care services and facilities to ensure complete medical records, accurate discharge reconciliation, and continuity of care.
Coordinate with the patient/family, care manager nurses, nurses, physicians, and the interdisciplinary team to ensure patient-centered care across the continuum.
Monitor resources and escalate clinical care as needed to support efficient and cost-effective care.
Evaluate post-hospital needs and develop transitions of care plans; initiate implementation prior to discharge.
Improve patient flow/throughput, continuity of care, patient satisfaction, safety, readmission prevention, and length of stay management.
Participate in daily multidisciplinary rounds and contribute to care coordination, discharge planning, and transitions of care planning.
Educate nurses, physicians, and the interdisciplinary team on resource utilization, medical necessity, CMS CoP for discharge planning, and care coordination.
Be knowledgeable about post-hospital services available to patients, including Home Health, Infusion, Durable Medical Equipment, Palliative Care, Hospice, Outpatient Services, Transitions of Care clinics, Skilled Nursing Facilities, Rehabilitation Services, and Community-based Organizations.
Qualifications
Master's in Social Work (MSW)
3 years experience in hospital/medical social work
Preferred Qualifications
Knowledge of state and federal guidelines pertinent to care management
Care Management discharge planning experience
LCSW (Licensed Clinical Social Worker)
ACM (Accredited Case Manager) or CCM (Certified Case Manager) preferred
This facility is an equal opportunity employer and complies with federal, state, and local anti-discrimination laws and regulations. Salary ranges reflect the anticipated base pay for this position and depend on skills and experience. Location may affect minimums and maximums.
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